Opinion: UnitedHealth's Medicare Advantage Practices Raise Ethical Concerns

The Wall Street Journal's recent investigation into UnitedHealth's practices reveals a troubling trend that warrants serious scrutiny. Doctors employed by UnitedHealth are reportedly handed a checklist of potential diagnoses before even examining Medicare Advantage patients. This practice, driven by company-provided software, requires doctors to weigh in on each suggested diagnosis before moving to their next patient—regardless of the relevance or accuracy of those suggestions.

In some cases, these diagnoses are so obscure that even experienced doctors must resort to Google for clarification. Take, for instance, the suggestion of secondary hyperaldosteronism, a condition so rare that it caught even medical professionals off guard. The motive behind this system becomes clear: more diagnoses equate to higher Medicare Advantage scores, which in turn translate into larger government payouts to insurers.

A Wall Street Journal analysis underscores the financial impact of this approach. Sickness scores—a measure used to determine patient health and allocate payments—increased significantly when patients transitioned from traditional Medicare to Medicare Advantage plans. Between 2019 and 2022, patients under UnitedHealth saw a staggering 55% increase in sickness scores during their first year in the plan, compared to just a 7% annual rise for those who remained in traditional Medicare.

This disparity is alarming. While the increase in scores may benefit insurers like UnitedHealth financially, it raises ethical concerns about patient care and the integrity of the Medicare system. Are these inflated scores genuinely reflective of patient health, or are they a byproduct of a system designed to maximize profit at the expense of accuracy?

Patients and taxpayers alike deserve better. The manipulation of sickness scores not only strains public funds but also risks undermining trust in healthcare providers. It’s time for greater oversight and accountability to ensure that healthcare decisions prioritize patient well-being over corporate greed.